Disclosures: During the years 2007–2012, W.A. Nolen has received grants from the Netherlands Organisation for Health Research and Development, the European Union, the Stanley Medical Research Institute, Astra Zeneca, Eli Lilly, GlaxoSmithKline, and Wyeth; has received honoraria/speaker's fees from Astra Zeneca, Lundbeck, Pfizer, and Wyeth; and has served in advisory boards for Astra Zeneca. None of the other authors have any financial disclosures.
COURSE AND RISK FACTORS OF FUNCTIONAL IMPAIRMENT IN SUBTHRESHOLD DEPRESSION AND ANXIETY
Article first published online: 16 NOV 2012
© 2012 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 30, Issue 4, pages 386–394, April 2013
How to Cite
Karsten, J., Penninx, B. W.J.H., Verboom, C. E., Nolen, W. A. and Hartman, C. A. (2013), COURSE AND RISK FACTORS OF FUNCTIONAL IMPAIRMENT IN SUBTHRESHOLD DEPRESSION AND ANXIETY. Depress. Anxiety, 30: 386–394. doi: 10.1002/da.22021
- Issue published online: 10 APR 2013
- Article first published online: 16 NOV 2012
- Manuscript Accepted: 13 OCT 2012
- Manuscript Revised: 18 SEP 2012
- Manuscript Received: 6 JUL 2012
- Health Research and Development. Grant Number: 10–000-1002
- VU University Medical Center
- GGZ inGeest
- Leiden University Medical Center
- GGZ Rivierduinen
- University Medical Center Groningen
- GGZ Friesland
- GGZ Drenthe
- Scientific Institute for Quality of Healthcare
- Netherlands Institute for Health Services Research
- Netherlands Institute of Mental Health and Addiction
- anxiety/anxiety disorders;
- mood disorders;
Although persons with subthreshold depression or anxiety are known to be at risk for full-syndromal disorders, little is known about their functioning over time. In this study, we investigate the functional impairment of persons with subthreshold depression or anxiety over time, compared to that of controls. Furthermore, we evaluate which illness, personal, and environmental risk factors influence its course.
Data come from the Netherlands Study of Depression and Anxiety (N = 1,266, aged 18–65). Linear mixed models were used to identify predictors of functional impairment at baseline, 1-, and 2-year follow-up. Risk factors were evaluated in their overall effect on functioning and on change in functioning over time, and whether they differed for respondents with and without subthreshold depression or anxiety.
Functional impairment in subthreshold respondents improved over time, but remained much higher than in controls. Prior anxiety disorder, high neuroticism, low conscientiousness, more somatic conditions, and more childhood trauma all predicted greater functional impairment. Older age predicted lower functioning only in subthreshold respondents, while the effect of neuroticism was stronger in subthreshold respondents relative to controls.
Functional impairment in subthreshold respondents improved over time, but remained elevated compared to that of controls. Given continuously elevated levels of impairment, preventive interventions should be focused on persons with subthreshold symptoms; in particular those with prior anxiety disorder, high neuroticism, low conscientiousness, somatic conditions, or childhood trauma.